Ready, Set, ICD-10. Denise M. Buenning, MsM Deputy Director Office of E-Health Standards and Services Centers for Medicare & Medicare Services

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1 Ready, Set, ICD-10 Denise M. Buenning, MsM Deputy Director Office of E-Health Standards and Services Centers for Medicare & Medicare Services

2 ICD-10 Compliance Date The compliance deadline for ICD-10-CM and PCS is October 1, 2014 ICD-10 DEADLINE Oct 1, 2014

3 ICD-10 and E-Health ICD-10 is a building block and integrates with all of e-health No longer a stand-alone, ICD-10 is integral to the spectrum of e-health initiatives Meaningful Use Stage 2 Quality Data, Quality Measures Hospital Value-Based Purchasing Quality Measurement and Reporting Accountable Care Organizations (ACO) & Innovations Reduces healthcare costs, improve quality, improve outcome

4 CMS ICD-10 Implementation Today Medicare Implementation The Medicare implementation is on track. Internal testing started. State Medicaid Agencies CMS conducted a State assessment in January 2013 and in early May May results currently are being compiled. Assessment response rate was 94% in January Providers Health plans, clearinghouses, large physician practices and hospitals are on target for ICD-10 implementation. CMS is providing small physician practices with additional technical assistance. Vendors Vendors are having discussions with their customers to ramp up ICD-10 efforts. 4

5 To Test or Not to Test? Medicare Fee For Service has announced that it will not conduct end-toend testing of claims with providers for ICD-10 Medicare FFS is confident that the current level of testing done each quarter for changes to the Medicare claims processing systems is effective. Medicare FFS follows a very rigorous system development life cycle testing protocol. System maintainers render alpha testing for one month, single testing contractor renders beta testing for two months, and the MAC s conduct user acceptance testing for one month. System changes to be completed in October 2013 with additional testing up to the October 1, 2014 implementation date. Industry health plans that may not have a similarly rigorous testing protocol in place should proceed with end-to-end testing to ensure continued reimbursement flow. This is no way signals any change in the implementation of ICD-10 on the October 1, 2014 date. OESS will continue to monitor payers best practices on testing, and keep industry apprised of these best practices as well as any testing changes/concerns that arise. 5

6 Working With the State Medicaid Agencies Quarterly Online ICD-10 Self-Assessments High level reports and graphics to help guide technical assistance ICD-10 Implementation Handbook Online tool providing SMA specific information to assist in ICD-10 Implementation State ICD-10 Collaboration Site Online community and repository for State Medicaid Agencies to communicate, collaborate, and innovate in the successful implementation of ICD-10 ICD-10 Bi-Weekly State Forum Conference call that allows CMS and States to discuss current issues related to ICD-10, and provides a vehicle for State-to-State collaboration on best practices and lessons learned in ICD-10 implementation ICD-10 Site Visit Training General and specific training geared to assist the SMA s ICD-10 implementation efforts ICD-10 Policy Briefs Demonstrations of how ICD-10 supports the Triple Aim through state programs for 9 different policies Health Condition Categories A foundation for SMAs to define health conditions in alignment with the needs of their specific agency 6

7 State Medicaid Agencies ICD-10 Provides an online community and repository for State Medicaid Agencies Provides SMA related ICD-10 resources from CMCS and SMAs Includes calendar of events for Medicaid ICD-10 Collaboration Site

8 Technical Assistance & Training

9 SMA ICD-10 Technical Assistance & Training Site Visits are customized to each state s needs and progress 8 Training Modules available for the states to choose from Conducted Regional Office visits Conducted 29 State Site visits (6 additional scheduled) Conducted 5 Policy Remediation Site visits (5 additional scheduled) 9

10 ICD-10 SMA Site Visit Training Content Illustrates some of the key business reasons that executives, directors, managers and all aspects of the organization should care about the implementation of ICD-10. Identifies the SMA core business functions and the ICD-10 impact. 10

11 ICD-10 State Medicaid Agency Implementation Handbook Contains information on the following core topics: Limitations of the current ICD- 9-CM code set Benefits of implementing ICD- 10 ICD-10 milestones Key activities Strategies and activities required to implement ICD-10 during the five implementation phases. 11

12 CHIP Nine Policy Briefs Show How ICD-10 Supports Healthcare Transformation for: Pregnancy Breast & Cervical Cancer Prevention HIV/AIDS Alzheimer s Disease Autism Spectrum Disorders Traumatic Brain and Spinal Cord Injuries Intellectual Disability Coordination of Care in State Medicaid Programs

13 ICD-10 Impact Across the Industry

14 ICD-10 and Physician Practices Source: AAPC/Ingenix

15 ICD-10 Resources: Medscape Two video lectures ICD-10: A Guide for Small and Medium Practices ICD-10: A Guide for Large Practices Expert article Transition to ICD- 10: Getting Started Modules on ICD-10

16 CMS ICD-10 Website Latest News Updates Provider Resources Payer Resources Vendor Resources GEMS ICD-9 Coordination and Maintenance Committee

17 Implementation Guides

18 Online ICD-10 Implementation Guide 18

19 Online ICD-10 Implementation Guide Contents

20 ICD-10 Website Resources ICD-10 Website ICD-10 Questions Mailbox Implementation Guides Mapping (GEMs) GEMs Crosswalk documents GEMs 2013 General Equivalence Mappings (Technical Document (zip file)

21 ICD-10 Website Resources (cont d) Medicare Learning Network Articles MLN/MLNGenInfo/index.html?redirect=/mlngeninfo ICD-10 National Provider Calls Teleconferences.html National Coverage Determinations (NCDs) Medicare Learning Network Materials and associated CRs available free on CMS web site for selected NCDs 21

22 Other ICD-10 Successes Federal Agencies Highlights CDC outreach/education/advocacy, Data Repository and shared training with other HHS OpDivs HRSA outreach via webinars and newsletters to HRSA grantees on ICD-10 NIH Identified key ICD-10 impact areas including registries and research IHS Steering Committee, Have No Fear of ICD-10 boot camp, clinical rounds, full-blown communications plan

23 CMS Point of Contact For More Information Denise M. Buenning, Deputy Director Office of E-Health Standards and Services